Chronic Care Background
The Systems Factor
- Our current healthcare system developed in response to infectious diseases and acute conditions (i.e. severe, one-time events) and is essentially an Acute Care Model. We have become proficient at treating these conditions and now more Americans are living longer and therefore developing more chronic conditions.
- Responding to this very different demand on our healthcare system will require profound changes in how physicians are paid, which healthcare benefits are offered, how doctors' offices are organized, how medical records are managed, and how clinicians are trained.
- People with five or more chronic conditions have an average of 15 physician visits and fill over 50 prescriptions a year; yet the current system rarely supports coordinated care and communication between these multiple physicians, or medication reconciliation when patients get prescriptions from more than one clinician.
- Most health insurance and care delivery organizations have put programs in place to help manage chronic diseases, but these are fragmented and cannot by themselves address reimbursement structures or transitions of care when patients move between health systems and insurance plans.
- Only 10-15% of American physician practices are using Electronic Medical Record systems and even fewer have patient registries which would enable them to better track and manage their patients with chronic illnesses who need frequent, ongoing care.
- A fast growing body of scientific medical research has resulted in the issue of proven treatment protocols for various medical conditions—but Americans receive evidence-based treatment for chronic illnesses only about 55% of the time (48% for diabetes).
- Physicians on the frontline simply cannot keep up by themselves with the growing complexity of medical care and they are not paid for the intensive time needed with patients to help them effectively manage an ongoing chronic illness. They need new support systems: new work processes, new technologies, and different financial incentives to support a new way of delivering care. We need a new model of care.
- Dr. Ed Wagner has developed an alternative to our current Acute Care Model. His Chronic Care Model is widely accepted as an effective framework for delivering better care to people with chronic illness.
“Inattention to diabetes and depression is contagious. We didn’t
respond to tuberculosis one case at a time. We need a community response to
a community crisis.” - Dr. Bruce Block, UPMC Shadyside Family Health Center
Sources:
"Chronic Conditions: Making the Case for Ongoing Care," Partnership for Solutions (Johns Hopkins University and the Robert Wood Johnson Foundation), September 2004 Update.
"Chronic Conditions" by Gerard Anderson; Expert Voices, January 2002, Issue 4.
McGlynn EA, Asch SM, Adams J, et al. "The quality of health care delivered to adults in the United States" New England Journal of Medicine 2003;348:2635-2645.